tbuckley/cabot-search huggingface dataset:
Abstract 12714: Impact of Reduced Left Ventricular Filling Pressure on Diastolic Function During Exercise in Patients With HFpEF
Authors: Syed A Abbas, Denis J Wakeham, Bryce Balmain, Andrew Tomlinson, Margot Morris, Raksa Moran, Marcus Payne, Mitchel Samels, Tony Babb, Benjamin D Levine, Satyam Sarma, James P Macnamara
Journal: Circulation (2022)

Background: During exercise, patients with heart failure with preserved ejection fraction (HFpEF) have an exaggerated increase in pulmonary capillary wedge pressure (PCWP) and left atrial-left ventricular pressure gradient (E wave velocity), as well as a blunted increase in early diastolic recoil (e’ velocity). It is unknown if non-invasive markers of diastolic function improve when exercise PCWP is acutely ameliorated. Methods: Patients with invasively proven HFpEF (n = 34, 71±6 years, 59% female, PCWP &gt; 25 or Δ15 mm hg at peak exercise) underwent 2 seated cycle exercise tests with sublingual nitroglycerin (NTG) and placebo (PLB) in a cross-over design. PCWP (right heart catheter), tissue Doppler velocities of the mitral annulus (e’) and mitral inflow velocities (E) were measured at rest and during 20-watt submaximal steady state exercise. Differences between placebo and GTN conditions were assessed by repeated measures mixed model. Results: PCWP was 7.6±3.9 mmHg at rest and 21.1±7.8 mmHg with sub-maximal exercise and was decreased by 14% and 24% respectively by NTG (Drug effect p &lt; 0.001, Figure ). Mean E’ was 6.2±1.5 cm/sec at rest and 8.8±1.7 cm/sec during exercise and was decreased by 6% and 8% respectively by NTG (p = 0.003), but augmentation during exercise was unchanged (NTG +36%, PLB +41%, p = 0.211). The E wave velocity was 69.6±21.2 cm/sec rest and 101.9±31.3 cm/sec during exercise and was decreased by 12% and 11% with NTG respectively (p &lt;0.001), but augmentation during exercise was unchanged (NTG +48%, PLB +46%, p = 0.507). Conclusions: NTG significantly and acutely lowered exercise PCWP in patients with HFpEF but did not improve diastolic function as assessed by echocardiography. The symmetrical slowing of E wave velocity and e’ with reduced PCWP demonstrate that higher preload helps maintain diastolic recoil and early diastolic filling for patients with HFpEF. Therapies that reduce preload in HFpEF may result in apparently worsened markers of diastolic function.
Abstract 12353: Clinical Outcomes of Telehealth in Coronary Artery Disease and Heart Failure Patients During Covid-19 Pandemic
Authors: Pauline Woo, Joanie Chung, jiaxiao M shi, Stephanie Tovar, Annette L Adams, Mingsum Lee
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic necessitated a rapid adoption of telehealth (TH). Few studies have assessed the safety of TH in subspecialty clinical practice. This study aimed to assess the clinical outcomes of TH use in patients with coronary artery disease (CAD) and/or heart failure (HF) during the initial phase of the COVID-19 pandemic as care delivery model shifted. Methods: This retrospective cohort study assessed continuously enrolled members in an integrated healthcare delivery system in the United States. Adult patients with CAD and/or HF with outpatient cardiology encounters from 3/1/2020 to 8/31/2020 (TH period) were identified via EHR using ICD-10 codes. Accounting for the dynamic shift in the proportion of TH use, patients were divided into two 3-month sub-cohorts (March-May, June-August) and compared with corresponding periods in 2019 (pre-pandemic period). The primary endpoint was outcome events including ED visits and hospitalization for any cardiovascular (CV) cause within 3 months follow-up. The secondary endpoint was cardiovascular events over 6 months of follow-up. Multivariable logistic regression was used to evaluate the association between TH use and CV outcomes. Results: The study cohort included 6485 patients with outpatient cardiology encounters during the TH period and 7557 patients during the pre-pandemic period. The mean age was 70 years, with 40% of patients being aged ≥ 75 and 35% being female. TH visits accounted for 0% of visits during the pre-pandemic period, compared to 68% during the TH period. Telephone visits comprised ≥ 92% of all TH encounters. Compared to the pre-pandemic period, patients seen during the TH period had fewer CV events 3 months after the index visits (aOR 0.77, 95%CI 0.66-0.89) and 6 months after the index visits (aOR 0.78, 95%CI 0.69-0.87). Subgroup analysis evaluating patients aged ≥75 showed similar findings. Conclusions: TH particularly via telephone visits accounted for a large share of ambulatory cardiology encounters during the initial phase of the COVID-19 pandemic. No increase in CV events was detected with the use of TH, suggesting that TH can be safely incorporated into ambulatory cardiology practice.
Abstract 11915: Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Left Ventricular Noncompaction
Authors: wei xu, Yan-min Yang
Journal: Circulation (2022)

Introduction: Left ventricular noncompaction (LVNC) is a limited knowledge myocardial disease. Risk stratification in such patients remains a controversy. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a valuable predictor for risk stratification in patients with heart failure. However, data on the effect of NT-proBNP on patients with LVNC is limited. This study aimed to evaluate the predicted effect of NT-proBNP on patients with LVNC. Hypothesis: NT-proBNP can be a predictor for adverse outcomes in patients with LVNC. Methods: This retrospective study enrolled 287 patients diagnosed with LVNC through imaging criteria (Jenni criteria or Petersen criteria). The primary endpoint was major adverse cardiovascular events (MACEs), which represented a composite event of all-cause death, heart transplantation, stroke/TIA, intracardiac thrombi, and venous thrombosis. Results: Patients were divided into 2 groups based on the median of NT-pro BNP: group 1(NT-pro BNP &lt;1008.1 fmol/L, n=143) and group 2(NT-pro BNP ≥1008.1 fmol/L, n=144). During a median of 2.8 years follow-up, 64 patients (22.3%) occurred MACEs. Patients in group 2 (36.8%) had a higher incidence of MACEs than group 1 (7.69%). The Kaplan-Meier curves showed that patients in group 2 were associated with a higher risk of MACEs (Log rank test, P &lt;0.001). Crude Cox regression model results revealed that log NT-proBNP levels were associated with increased risk of MACEs (Crude HR 4.49, 95% CI 2.84-7.09, P &lt;0.001). After adjusting for risk factors including BMI, systolic blood pressure, NYHA functional class, hypertension, prior thromboembolism, atrial fibrillation, left atrial diameter, and LVEF, log NT-proBNP level was an independent risk factor for MACEs (Adjusted HR 2.72, 95% CI 1.53-4.82, P &lt;0.001). The ROC curves showed that the AUC of NT-proBNP was 0.767. Conclusions: NT-proBNP was independently associated with MACEs and can be a robust predictor for the risk stratification in patients with LVNC.
Abstract 11414: Anti-Mir-7110-3p as a Therapeutic Molecule in Monocrotaline Induced Pulmonary Arterial Hypertension Rat Model
Authors: Auxzilia Preethi K, Sushmaa Chandralekha Selvakumar, Durairaj Sekar
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PAH) is a chronic condition marked by unusually increased blood pressure in the pulmonary artery which transports blood from the heart to lungs. Advances in PAH treatment have improved PAH patients outcomes and prognosis, but still continues to be a life-threatening condition and also the current treatment strategies have failed to address the underlying cellular and molecular problems. MicroRNAs are short noncoding RNAs that suppress gene expression by binding to the 3' UTR of their target mRNA. According to our prior findings, there is evidence that miR-7110 has a prominent role in PAH. Hypothesis: In this study, we assessed the hypothesis to determine whether anti-miR-7110-3p can help to prevent PAH in monocrotaline-induced PAH (MCT-PAH) rat model via PKCδ/STAT3 signaling pathway. Methods: Pulmonary arterial smooth muscle cells (PASMCs) were transfected with anti-miR-7110-3p to investigate the effect of miR-7110-3p on PASMCs proliferation and apoptosis in in vitro condition. To induce PAH, male Sprague Dawley rats were given an intraperitoneal injection of 50 mg/kg monocrotaline. The expression of miR-7110-3p/PKCδ/STAT3 were assessed using RT-qPCR and western blotting analysis, while the activity of miR-7110-3p and its target STAT3 was determined using luciferase reporter assay. Systolic pulmonary arterial pressure was recorded using PowerLab data acquisition system and after obtaining the readings the rats were immediately sacrificed. The lower lobe of right lung tissue was collected, fixed in 4 % paraformaldehyde, sectioned and processed for histological analyses. Results: Our results demonstrated that miR-7110-3p has a proliferative and anti-apoptotic effect on PASMCs. Additionally, in vitro studies revealed that miR-7110-3p/ PKCδ/STAT3 axis in involved in PAH. Our histological analyses suggested that anti-miR-7110-3p was able to reduce the pulmonary vascular remodeling. As a result, the relationship between miR-7110-3p, STAT3 and anti-miR-7110-3p is an important step in gene expression analyses. Conclusions: In conclusion, our findings suggest that miR-7110-3p may be used as a biomarker and anti-miR-7110-3p can be used as a therapeutic molecule for the treatment of PAH.
Abstract 11605: Association of Patient Characteristics and Center on Age of Fontan Completion: A Retrospective Cohort Study Using the Pediatric Health Information Systems Database
Authors: Bethan Lemley, Russell Shinohara, Oluwatimilehin Okunowo, Steve Ampah, David Goldberg, Jack Rychik, Andrew C Glatz, Sandra Amaral, Michael O'Byrne
Journal: Circulation (2022)

Introduction: Little is known regarding optimal timing of the Fontan operation and whether timing affects outcomes in patients with single-ventricle heart disease. The association of patient-level factors with age at the Fontan operation and the degree of practice variation among surgical centers have not been quantified in large studies. Methods: A retrospective cohort study of patients who underwent a Fontan operation between 1/1/2007 and 12/31/2017 at Pediatric Health Information Systems Database centers was performed to evaluate associations between patient characteristics and center on timing of Fontan operation. Mixed-effects multivariable linear regression was used to adjust for patient characteristics and center-level covariance. Results: In all, 7,840 patients (41% male, 57% white) at 46 centers were included. Median age at Fontan was 3.3 years (IQR 2.5-4.3). In an adjusted model hypoplastic left heart syndrome (-16 months, 95% CI -18 to -13), heterotaxy (-9 months, 95% CI -13 to -5), and ECMO history (-11 months, 95% CI -17 to -5) were associated with younger age at Fontan. Non-cardiac diagnoses (+4 months, 95% CI 0.1-9) and technology-dependence (+21 months, 95% CI 16-25) were associated with older age at Fontan ( Figure 1A ). There was no evidence of racial differences in Fontan timing. Children with Medicaid insurance were significantly younger at Fontan than counterparts with other insurance. We observed center effects on age at Fontan (p&lt;0.001, ICC 0.03 95% CI 0.02-0.05) with youngest median age of 0.9 years (IQR 0.6-2.8) at one center and oldest median age of 5.0 years (IQR 4.6-5.9) at another center ( Figure 1B ). Conclusion: In this study, age at Fontan was significantly associated with cardiac anatomy, non-cardiac diagnoses, ECMO history, and insurance but not race. There was practice variation between centers in Fontan timing. Future studies will examine associations between timing of Fontan and patient outcomes.
Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry
Authors: Yasser Sammour, Samarthkumar Thakkar, Safi U Khan, BUDHADITYA BOSE, Rakesh Gullapelli, Charlie Nicolas, Nwabunie Nwana, Shubham Lahan, Trisha Roy, Alan B Lumsden, Neil S Kleiman, Sadeer Al-Kindi, Garima Sharma, Kershaw Patel, Miguel Cainzos, Stephen Jones, William A Zoghbi, Khurram Nasir
Journal: Circulation (2022)

Introduction: Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in &gt;1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature (&lt;65 years) PVD in a large integrated healthcare system. Methods: Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes. Results: We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% &amp; 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any &amp; premature PVD was higher with worse ADI groups ( Table ). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5 th ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories &amp; 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood). Conclusion: Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.
Abstract 12228: Development of a Novel Polygenic Risk Score to Predict Risk of Aortic Stenosis Events
Authors: Aeron M Small, Giorgio Melloni, Frederick Kamanu, Carolina Roselli, Brian A Bergmark, Marc P Bonaca, Michelle L Odonoghue, Robert Giugliano, Benjamin M Scirica, Deepak L Bhatt, Elliott M Antman, Itamar Raz, Gina Peloso, PETER WILSON, Christopher J Odonnell, Pradeep Natarajan, Eugene Braunwald, Steven A Lubitz, Patrick T Ellinor, Christian T Ruff, Marc S Sabatine, Nicholas F Marston
Journal: Circulation (2022)

Introduction: Aortic stenosis (AS) is the most common valvular heart disease. Polygenic risk scores (PRS) use common genetic variants to enhance risk prediction for disease but have not yet been applied in AS. Methods: We generated an AS genetic risk score using summary data from a recently performed GWAS in the Million Veteran Program and score selection performed in the UK Biobank. We analyzed investigator reported adverse events with either newly identified AS or worsening of AS (including heart failure in the setting of AS or aortic valve replacement) from 5 TIMI trials (FOURIER, PEGASUS, SAVOR, SOLID, and ENGAGE). Cox proportional hazard models (adjusted for age, sex, diabetes, BMI, hyperlipidemia, and the first 5 principal components) were used to generate adjusted hazard ratios for risk of AS evaluating normalized PRS as a continuous variable. Results: The best performing AS PRS used a p-value threshold of 5x10 -8 and consisted of 27 independent single nucleotide polymorphisms which together predicted AS in the UKBB with a p-value of 2.6x10 -5 . In the TIMI trials, there were a total of 52,183 individuals (median age 66 years [interquartile range 60-72], 71.7% male) with a median follow up of 2.4 years. Of these, 215 (0.4%) had an AS-related adverse event. Age was the strongest clinical risk factor for an AS-related adverse event (HR 1.08 [1.06-1.10] per 1-SD, p-value 1.8x10 -19 ), followed by diabetes and BMI. After adjustment for all clinical risk factors there was a 16% increase in the risk of an AS-related adverse event with each standard deviation (SD) increase in the AS PRS (HR 1.16 [1.02-1.31] per 1-SD, p-value 0.03). Conclusions: We developed a novel polygenic risk score that predicts clinical risk of aortic stenosis-related adverse events in patients with cardiometabolic disease, even after adjustment for traditional risk factors.
Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium
Authors: Christopher T Smith, Walter Rentrop, John Raper, Daga Olsen, Sasha Sharifi, AMY PARKER, Tara George, Sophia Thang, Anjula Chib, Vivek Menon
Journal: Circulation (2022)

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA). - We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up. - Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR). - This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.
Abstract 11518: Incidence of Peripheral Arterial Disease in Patients With Coronary Artery Disease Following Cardiac Catheterization: A Prospective Observational Study
Authors: Sanjot Sunner, Robert C Welsh, Kevin R Bainey
Journal: Circulation (2022)

Introduction: Peripheral arterial disease (PAD) is a common vascular condition affecting roughly 800,000 Canadians annually with up to 50% being asymptomatic. As such, PAD is underdiagnosed and undertreated, despite being an independent predictor of cardiovascular (CV) risk. Moreover, PAD is commonly seen in patients with coronary artery disease (CAD) due to their shared atherosclerotic pathophysiology. Our aim was to gain a better understanding of the incidence and symptomatology of PAD in patients with established CAD on coronary angiography. Methods: Prospective subjects with CAD demonstrated on coronary angiography were immediately screened for PAD at the Mazankowski Alberta Heart Institute Cardiac Catheterization Laboratory. Following consent, a bedside ankle-brachial-index (ABI) (Microlife WatchBP Office ABI) was performed and the Edinburgh Claudication Questionnaire (ECQ) (validated for PAD) was administered. PAD was defined as an ABI≤0.90. Results: We recruited 100 patients (67.5 age ± 9.5 years, 18.0% female) between June 2021 to April 2022. Eighteen subjects (18.0%) had PAD as demonstrated by an abnormal ABI. In those with diabetes (n=34), PAD was more frequent (26.5% vs. 14.1%, p=0.068). Kappa agreement between ECQ and ABI was 0.32. Conclusions: In a prospective cohort of angiographically confirmed CAD patients, one-quarter had ABI confirmed PAD (even more common in diabetics). The ECQ provided modest agreement with ABI suggesting many of these subjects are asymptomatic. ABI can be used as a simple non-invasive tool at the bedside following cardiac catheterization to screen for PAD which has implications on subsequent guideline-directed medical therapy.
Abstract 12506: Assessment of the Left Ventricular Trabeculation Phenotype Contributes to Risk Stratification in Hypertrophic Cardiomyopathy Patients
Authors: Yu Zhang, Yuming Zhu, Lianjun Xu, Qiya Huang, Guixin Wu, Jizheng Wang, Channa Zhang, Xiaolu Sun, Wen Jiang, wang dong, Lianming Kang, lei song
Journal: Circulation (2022)

Aims: To investigate clinical values associated with the “left ventricular (LV) trabeculation phenotype” that did not meet the diagnostic criteria of LV noncompaction (LVNC) in hypertrophic cardiomyopathy (HCM). Hypothesis: The presence of left ventricular trabeculation phenotype was associated with a poor prognosis in HCM patients. Genetic factors contributed to this particular phenotype. Methods: A total of 940 HCM patients were recruited. The primary endpoint was cardiovascular death; the secondary endpoints were sudden cardiac death (SCD) and all-cause death. The LV trabeculation phenotype was assessed by cardiac magnetic resonance. Baseline and survival analyses regarding the LV trabeculation phenotype were conducted in general HCM patients and obstructive subset. A combination model was constructed by adding the LV trabeculation phenotype to the HCM risk-SCD model. The whole exome sequencing was used for genetic analysis. Results: The LV trabeculation phenotype was recognized in 34.5% HCM patients and was mostly observed at the apex and free wall. Patients with the LV trabeculation phenotype were younger, had a higher prevalence of family history of SCD and more frequent presence of late gadolinium enhancement. Cox proportional hazards regression analysis showed that the LV trabeculation phenotype increased the risk of cardiovascular death (P=0.031), SCD (P=0.008), and all-cause death (P=0.047) in obstructive HCM patients. Furthermore, the LV trabeculation phenotype-combined model improved risk stratification for SCD. The genetic analysis showed that DTNA variants were more frequently identified in patients with the LV trabeculation phenotype. Conclusions: The LV trabeculation phenotype contributes to risk stratification in obstructive HCM, thus this parameter should be assessed in obstructive HCM patients even if the degree of trabeculation does not fulfil the LVNC criteria. DTNA mutation underlies the cause of this phenotype.